Avascular necrosis of the scaphoid following a fracture is most common in the proximal pole of the bone. This is because, in most people, the blood supply to the scaphoid enters the scaphoid distally and passes proximally through the waist.
Necrosis usually develops after 2-3 months and appears dense on a plain radiograph of the wrist. Untreated, it will eventually cause osteoarthritis of the wrist.
A bone graft may succeed in restoring structural integrity.
Pain is an indication to excise the necrotic fragment and the radial styloid.
Secondary osteoarthritis may be treated by permanent splintage, prosthetic replacement or wrist arthrodesis.
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